Mark Denegre
Individual provider Active NPI Optician · Centerbrook, CT
NPI 1659446342 · NPPES record last updated Jan 23, 2008
Key facts
- NPI
- 1659446342
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Optician 156FX1800X
- License
- 780 (CT)
- Practice address
- 90 Main St
Suite 101
Centerbrook, CT 06409-1056 - Phone
- (860) 767-3206
- Fax
- (860) 767-0836
- NPI assigned
- Nov 21, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Wild Apple Eye LLC | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optician | 156FX1800X | 780 | CT | Yes |
Addresses
Primary practice location
90 Main St
Suite 101
Centerbrook, CT 06409-1056
Mailing address
90 Main St
Suite 101
Centerbrook, CT 06409-1056
Phone (860) 767-3206
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 200001396CT01 | Other | CT | ANTHEM |
| 1909 | Other | CT | DAVIS VISION |
Other providers in Centerbrook, CT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 23, 2008. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.